Lamey D M, Fernandez D L
Lindenhof Hospital, Bern, Switzerland.
J Bone Joint Surg Am. 1998 Dec;80(12):1758-69. doi: 10.2106/00004623-199812000-00005.
We reviewed the results of a modified Sauvé-Kapandji procedure with tenodesis of the flexor carpi ulnaris to the carpus in eighteen patients who had chronic derangement of the distal radioulnar joint. There were fourteen men and four women. The mean supination of the forearm had improved from 16 degrees (range, 0 to 75 degrees) preoperatively to 76 degrees (range, 40 to 90 degrees) at the time of the latest follow-up, and the mean pronation had improved from 42 degrees (range, 0 to 80 degrees) preoperatively to 81 degrees (range, 60 to 90 degrees) at the time of follow-up. Pain relief was satisfactory, and the mean grip strength had improved from 36 percent of that on the unaffected side preoperatively to 73 percent at the time of follow-up. One patient had moderate pain over the ulnar stump associated with residual volar instability of the proximal ulnar segment, and he had a tenodesis of the extensor carpi ulnaris as a second procedure. Another patient had mild instability of the stump only after he had a second operation, which was an excision of a bone mass (ossification) in the resected area. The ulnar stump was stable in sixteen patients. Eight of the eleven patients who had performed heavy manual labor before the injury were able to return to work full-time without restrictions. According to a modification of the wrist-scoring system of the Mayo Clinic, at a mean of four years and two months (range, two years to eight years and four months), six patients had an excellent result; seven, a good result; four, a fair result; and one, a poor result. On the basis of our findings, we believe that the index operation is an excellent salvage procedure for the treatment of chronic posttraumatic derangement of the distal radioulnar joint, especially when nonoperative treatment has been unsuccessful and rotation of the forearm is severely limited.
我们回顾了18例桡尺远侧关节慢性紊乱患者采用改良Sauvé-Kapandji手术并将尺侧腕屈肌固定于腕骨的治疗结果。其中男性14例，女性4例。前臂平均旋后角度从术前的16度（范围0至75度）改善至末次随访时的76度（范围40至90度），平均旋前角度从术前的42度（范围0至80度）改善至随访时的81度（范围60至90度）。疼痛缓解情况令人满意，平均握力从术前占健侧的36%提高至随访时的73%。1例患者尺骨残端有中度疼痛，伴有尺骨近端掌侧残留不稳定，他接受了尺侧腕伸肌固定术作为二期手术。另1例患者仅在二次手术后出现残端轻度不稳定，二次手术为切除切除区域的骨块（骨化）。16例患者的尺骨残端稳定。11例伤前从事重体力劳动的患者中有8例能够不受限制地全职重返工作岗位。根据梅奥诊所腕关节评分系统的改良标准，平均随访4年2个月（范围2年至8年4个月）时，6例患者结果为优；7例为良；4例为中；1例为差。基于我们的研究结果，我们认为该手术是治疗桡尺远侧关节慢性创伤后紊乱的一种优秀的挽救手术，尤其是在非手术治疗失败且前臂旋转严重受限的情况下。
